Antibiotic resistance: how to tackle a public health crisis
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The Financial Times hosted discussions in December 2020 and February 2021 on progress and policy options to tackle antimicrobial resistance, as part of a special report series on the Future of Antibiotics. The meeting brought together senior representatives from governments, non-profit and international organisations, academia, medical centres, the investment community and the pharmaceutical sector. It was held under the Chatham House rule of non-attribution, but below is a summary of the main discussion points and recommendations:
There have been important advances in recent months towards tackling antibiotic resistance, with new financing programmes, regulations and political declarations. Yet drug resistance continues to rise; there are significant gaps in tracking resistance; and there remains an urgent need to develop new drugs, vaccines, diagnostic tools and stewardship protocols.
Coronavirus has diverted attention from this crisis while intensifying the risk of antimicrobial resistance through treatment of secondary infections and misdiagnosis. Yet the fresh focus on public health during the pandemic has also provided a reminder of the dangers of infectious disease and the need for investment in systems to respond. The meetings of the G20, G7 and COP26 this year provide opportunities for governments to tackle the issue with renewed focus and tangible commitments.
To tackle the “broken pipeline” of research of new antibiotics, there has been a growth in “push” funding to support early stage research co-ordinated by organisations including the Global Antibiotic Research and Development Partnership and CarbX, supplemented by later-stage funding for development and testing provided by the AMR Action Fund.
There is fresh attention on the need for more “pull” funding to incentivise and reward the development of new medicines successfully launched. The UK’s National Institute for Health and Care Excellence has launched a pilot, as have the Swedish authorities.
There are indications that there would be bipartisan support for the proposed Pasteur Act in the US, which would provide substantial upfront funding for new antibiotics that win regulatory approval.
New initiatives are exploring the development of antibiotics specifically for animals, to avoid use of drugs useful to humans and to limit the development of resistance.
Regulatory measures include a pending EU ban from 2022 on antibiotic use in animals without authorisation from a vet. A new EU action plan includes work on audits to help support member states in the development of national plans.
Investors have stepped up scrutiny of the use of antibiotics in the food chain, and are working with companies including the pharmaceutical industry to cut down on antibiotic waste entering the water supply, and improve stewardship of drugs. The G7, G20 and new inter-governmental initiatives such as the World Health Organization’s Global Leaders Group have demonstrated rising interest in the problem.
What is needed
New tools to incentivise the development and responsible use of drugs, vaccines for diseases that are treated with antibiotics, and diagnostics.
Greater efforts to support more equitable and responsible use of new and existing drugs.
More focus on limiting the excessive use of antibiotics in meat production and agriculture.
More and better communication to raise understanding of the rising dangers of antibiotic resistance and consider the response as investments of global benefit.
Keeping up the pressure for progress by enlisting governments, investors, consumers, patients and civil society to develop targets and monitor actions. In particular, lower and middle income countries — led by “regional champions” such as South Africa, Brazil and India — need to be more involved in investment, monitoring, stewardship and access.
Governments should develop comprehensive national action plans that include detailed targets, are linked to funding commitments and are updated regularly to enable tracking of progress.
Public spending on combating drug-resistance should be treated as investment in essential infrastructure to improve pandemic preparedness, global health security and the integration of “one health” spanning human, animal and environmental wellbeing. Bodies such as the OECD should explore how this can be reported in national accounts. The IMF should include scrutiny in its Article IV country reviews of national health systems, their capacity to tackle antibiotic resistance and the associated financial risks.
Investors should step up scrutiny of governments and companies to consider the ethical and economic risks of antibiotic resistance and the nature of the response.
Regulators should require more detailed labelling of foods to declare any antibiotic content; explore the introduction of import bans on any that are not certified as antibiotic-free; and increase transparency in the supply chain for restaurants.
Tougher international guidance should be introduced to limit the use of antimicrobial pesticides in agriculture.
Health systems should share experiences and approaches to better assess the cost effectiveness and broader benefits of antibiotics to public health as well as to individual patients.
Medical systems should explore emerging models for funding new antibiotics that de-link payment to drug companies from volumes of usage. Potential approaches include upfront prizes and subscription or insurance models that provide an annual payment to manufacturers.
Lower and middle-income countries should work together to pool resources for the procurement of new antibiotics for coupled with stewardship measures to control use.
The EU and multilateral organisations should set standards for and mechanisms to support more equitable access in different countries to off-patent antibiotics and diagnostics in order to offer broader access to the most effective treatments and limit the spread of resistance.
Leading international medical regulators should harmonise clinical trials to permit more effective, quicker and cheaper testing of novel antibiotics in lower-income countries.
Funders should explore enhanced financial incentives for new research and development, including through a European equivalent of the US’s Biomedical Advanced Research and Development Authority.
Recommendations for the G7
Stress the importance of fighting antibiotic resistance as an integral part of global health security and future pandemic preparedness, and place a human and monetary value on the cost of inaction as well as stating the funding required
The G7 countries should each pledge new mechanisms and incentives. Existing examples that could be replicated include programmes offering higher guaranteed payments for antibiotics in the UK and Sweden, and the proposed Pasteur Act in the US.
Acknowledge the “market failure” in antibiotics, the need to de-link revenues for new drugs from volumes used, while also finding ways to reward responsible use and high-quality production standards.
Endorse a road map that commits finance ministers to develop incentives for antibiotics that satisfy unmet public health needs and report back at next year’s G7 meeting. Launch an initiative to develop ways to reallocate antibiotic expenditure from current spending to infrastructure investment in national accounts.
Stress the need for population-wide cost-benefit assessments such as those used by Britain’s National Institute for Health and Care Excellence, including “therapeutic value-added” and “quality-adjusted life years gained” approaches.
Agree to develop a common framework for calculating resistance and forecasting spread.
Recognise the need to switch from broad to narrow spectrum antibiotics as they become available. Urge the introduction of national guidelines and easier registration of antibiotics between countries.
Stress the need for a global approach to affordable access to all appropriate antibiotics including existing and generic medicines as well as new drugs. Agree a global mechanism on cost-sharing in proportion to GDP.
Commit to increasing the use of diagnostics before prescribing antibiotics by 25 per cent annually from 2023 to reduce consumption and improve surveillance.
Require transparency in the medicine supply chain, such as in New Zealand.
This article was updated in March 2021 with recommendations for the G7 meeting of world leaders
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